USMLE Guide: Menopause and Hormone Replacement Therapy

Introduction:

Menopause is a natural stage in a woman's life when her menstrual cycles cease, typically occurring between the ages of 45 and 55. It is characterized by a decline in ovarian function, leading to a decrease in hormone production, particularly estrogen and progesterone. Menopause can cause various physical and psychological symptoms, and hormone replacement therapy (HRT) is one of the treatment options available. This USMLE guide aims to provide an overview of menopause, its symptoms, and the use of hormone replacement therapy.

I. Menopause:

A. Definition and Stages:

1. Menopause: The permanent cessation of menstruation for a period of 12 months due to the loss of ovarian follicular activity.
2. Perimenopause: The transitional phase leading up to menopause, characterized by hormonal fluctuations and irregular menstrual cycles.
3. Postmenopause: The period after menopause.

B. Symptoms:

1. Vasomotor symptoms: Hot flashes, night sweats, and flushing.
2. Genitourinary symptoms: Vaginal dryness, dyspareunia, and urinary symptoms.
3. Psychological symptoms: Mood swings, irritability, anxiety, and depression.
4. Sleep disturbances, fatigue, and cognitive changes.

C. Diagnosis:

1. Based on clinical symptoms and menstrual history.
2. Follicle-stimulating hormone (FSH) levels: Elevated FSH levels (>30 IU/L) due to decreased ovarian activity.
3. Hormone testing is not necessary in most cases.

II. Hormone Replacement Therapy (HRT):

A. Definition:

1. HRT: The use of exogenous hormones to supplement or replace the declining endogenous hormones during menopause.

B. Types of HRT:

1. Estrogen-only therapy (ET): Recommended for women who have undergone hysterectomy (surgical removal of the uterus).
2. Estrogen-progestin therapy (EPT): Recommended for women with an intact uterus to prevent endometrial hyperplasia.

C. Benefits of HRT:

1. Relief of vasomotor symptoms, genitourinary symptoms, and psychological symptoms.
2. Maintenance of bone density, reducing the risk of osteoporosis and fractures.
3. Improvement in sleep quality and cognitive function.

D. Risks and Side Effects of HRT:

1. Increased risk of breast cancer (combined EPT), especially with long-term use.
2. Increased risk of venous thromboembolism (VTE), stroke, and cardiovascular disease (combined EPT).
3. Endometrial hyperplasia or cancer with unopposed estrogen therapy (ET).
4. Nausea, breast tenderness, bloating, and breakthrough bleeding.

E. Contraindications to HRT:

1. History of estrogen-dependent neoplasms (e.g., breast cancer).
2. History of VTE, stroke, or cardiovascular disease.
3. Undiagnosed vaginal bleeding.
4. Active liver disease or liver dysfunction.

III. Monitoring and Follow-up:

A. Regular Follow-up:

1. Evaluate the patient's response to HRT and symptom relief.
2. Assess and manage any side effects or complications associated with HRT.
3. Re-evaluate the need for continued HRT based on the patient's overall health profile.

B. Recommended Monitoring:

1. Annual mammography for women on HRT.
2. Regular blood pressure monitoring.
3. Regular pelvic exams.
4. Bone mineral density testing as indicated.

Conclusion:

Menopause is a natural process that brings about various physical and psychological changes in women. Hormone replacement therapy (HRT) is an effective treatment option for relieving menopausal symptoms and reducing the long-term risks associated with estrogen deficiency. However, the benefits and risks of HRT should be carefully considered based on each patient's individual profile, and regular monitoring is essential to ensure the safety and efficacy of treatment.

Note: This USMLE guide provides a concise overview of menopause and hormone replacement therapy. For a more comprehensive understanding, please refer to the complete article titled "Menopause and Hormone Replacement Therapy."